GLOBAL AEROSPACE UNDERWRITING MANAGERS (CANADA) LIMITED100 Renfrew Drive, Suite 200, Markham, Ontario DR 9R6 • Tel. (905) 479-2244 • Fax: (905) 479-0751

GLOBAL AEROSPACE

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Commercial Application Form

A. NAME:

B. ADDRESS:

C. PRINCIPALS (with some background including how long employed in that position)

Owners:

President:

Chief Pilot:

Operations Manager:

Chief Engineer:

Others of Note:

D. FACILITIES

Bases:

Descriptions:

E. OPERATIONS

On the following page is a chart that is to be completed in full outlining the details ofyour operation. Please ensure that this is

completed as accurately as possible. In addition:

How long have you been in operation?

Please advise any material points regarding your operation not described on the next sheet.

Do you advertise your operation in the United States?

Describe any operations you have involving flights into the United States.

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F.

CHECKLIST Regular % Rare if Notever Anticipated

(Put an "X" and "%" in the appropriate spot)

Schedule Work. Please provide details of all routes andfrequency of flights. Attach schedules.

Charter Work

Flying Club

Total (the above categories must equal 100%)

Charter Work (breakdown this work by cargo and people listedbelow as a percentage to the total charter work you do).

Cargo

People (state overall activity and then breakdown this by thea) & b) categories below).

a) Transportation of people in course of their work

b) SightseeingfTourism (including guests to Lodges)

i) Canadian Residents

ii) US or Foreign Residents

Specific Work

Survey

Mining - Oil/Gas

Power/Pipeline Patrol

Air Ambulance

Traffic Patrol

Spraying - Agricultural

Rental

Training - Ab Initio

- Advanced

- Recurrent - Employees

- Outsiders

Specific Work

Forestry - Patrol

- Logging

- Shakes

- Fire Bucket

- Personnel Support

Slung Cargo

Heli Skiing

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G. CURRENT PILOT ROSTER

N.B. Times shown may not be exact but best available by your records at this time.

uDescribe all accidents and violations. Use separate sheet if necessary.

FIXED WING EXPERIENCE

Name Age Total Total Total Time on Aircraft to Total last Accidents""

Time Floats MIE Type be flown 12 months

ROTARY WING EXPERIENCE

Name Age Total Total Time on Aircraft to Last 30 Total last Accidents**

Time Turbine Type be flown Days 12 months

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H. MISCELLANEOUS

1. Proposed expansion or changes of nofe:

2. Other pertinent or information of interest:

3. Non-Owned Aircraft Liability:

(a) Annual Hours (if any) you used aircraft not owned and not insured by you _

(b) Maximum number of seats in the aircraft _

(c) Name of Operator _

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I. SCHEDULE OF AIRCRAFT

Item Reg'n. Make & Hull coverages Agreed Passenger Limit of Utilization ExpectedNo. Model required Value Seats Liability next 12 months

State None, ARFGorARG (excluding

pilot) Days Hours

ARFG - All Risks Flight and GroundARG - All Risks Ground

SPARES: (Parts & Equipment, Tools, Ground Handling, etc.):

(a) Total value of all spares for coverage $ _

(b) Maximum anyone location $ _

(c) Do you have your spares computerized? _

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J. LOSS & VIOLATION HISTORY

Give a brief description of any accidents that you, your operation, or any of your pilots have had in the

past 5 years, including date of loss, brief details involving accident, amount of loss:

Give a brief description of any violations that you, your operation, or any of your pilots have had in the

past 5 years:

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K. GENERAL LIABILITY INFORMATION

1. Premises Liability

(a) Any locations to be noted other than your main base? ~ ~ ~~ ~~__

(b) Do you lease or own your main base? ,Are you the sole occupant of the building? If not who else shares?

(c) Please give a description of your main base (age, size, heating, construction)_~ _

(d) Limits required: _

MaximumAverage

Hangarkeepers Liability

(a) Do you regularly store or have in your care, aircraft owned by others? _

(b) If 'Yes" to (a)

2.

(a) Value of anyone aircraft

(a) Value of all aircraft

$------

$------

$

$

(c) Do you have any test flights to customer aircraft? _

If so, what is the maximum value of aircraft, and give type expected? _

(d) Do you obtain a waiver from the owner(s)? If so, attach copy of waiver sample. _

(e) Limits required: Anyone aircraft Anyone occurrenC8 _

3. Products Liability

Indicate your gross receipts from others for any of the following expected in the next twelve months:

(a) Fuel and Oil Sales

Aircraft Parts Installed

Sold

New Aircraft

Used Aircraft

Labour Running Maintenance

Labour Repair & Overhaul

(b) Limits required: ~

$-----------­

$,-----------­

$,-----------

$,------------

$,----------­

$,-----------­

$,------------

Complete Description on Page 8

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I declare that the statements and declarations given are true and that no information has been withheld that might influenceacceptance of this proposed insurance; and I agree that the statements and declarations given above and signed by me shallbe the basis of my contract between myself and Global Aerospace. This application does not commit Global Aerospace toany liability nor make the Applicant liable for any premium unless and until Global Aerospace agrees in writing that coveragehas been bound.

Name of Broker Signature of Applicant _

Phone Number Fax Number

GLOBAL AEROSPACE

GLOBAL AEROSPACE UNDERWRITING MANAGERS (CANADA) liMITED100 RENFREW DRIVE, SUITE 200, MARKHAM, ONTARJO L3R 9R6 TEl, (905) 479-2244 FAX' (905) 479-0751

Date _